Salary Authorization Form

Salary Authorization Form

Please fill out this form completely to streamline the adjustment process.

Employee Information

Name

    Position

      Employment Status

        • Full-Time

        • Part-Time

        • Contract

        • Freelance

        Adjustment Details

        Request Date

          Reason for Increase

            • Performance-Based

            • Promotion

            • Market Adjustment

            • New Job Responsibilities

            Current Salary

              Percentage of Increase

                New Salary

                  Effective Date

                    Approval (for management only)

                    The request has been:

                    • Approved

                    • Declined: Specify Reason

                    Supervisor

                    Name:

                    Date:

                    HR

                    Name:

                    Date:

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